Before addressing the issues I’ve alluded to in the title of this article, here’s a quick review of what’s important if an adult comes to you claiming they have ADHD.  First, and most important, there is no such thing as new, first-time onset of ADHD in adulthood. Symptoms had to have been present before age 12 and continued on throughout adulthood unchecked – because the person wasn’t ever diagnosed, was diagnosed incorrectly or had decided to just fight through the symptoms. So, when an adult seeks your services for ADHD-like complaints, the first thing to do is assess their motivation. Inquire as to why they’re coming in for an evaluation at their current age, and whether there have been any major life changes recently. What you’re trying to ascertain is when the symptoms really started and the impact they have had on the person’s life.

Adults who really have ADHD not only report significant impairment, but also a host of ramifications with having lived with the disorder for often 30-40 years or more.  Here are three of them, which in my experience surface most often:

Shame

Shame of course, crosses over into many of the maladies for which people seek mental health treatment, and ADHD is indeed one of them. Adults with ADHD accompanied by shame are cognizant of what needs to be done, and even how to do it, but can’t execute – often working themselves excessively hard merely to stay afloat. To help them cope more effectively, raise their awareness to the negative chatter in their heads – the inner critic creating negativity, doubt and self-defeating worry.

Three steps for taming the inner critic:

  1. Help them become more aware of the “voice” and when it pops up, by starting to notice red flags and redirecting themselves to the present – “Oh, there’s that negative messaging again.”
  2. Have them write out what the critic is saying:
    “I will never get this project done.”
    “I am definitely going to get fired.”
    “I will never learn this.”
  1. Then use a counter-statement prepared in advance:
    “It doesn’t need to be perfect.”
    “I have tremendous value to offer.”
    “I’m working at making gradual, steady progress.”

Relationship Issues

Relationships where one (or both) members have ADHD can be troubled by misunderstandings, frustrations and resentments – creating a nasty tug-of-war. The individual with the disorder often feels constantly criticized, nagged and micromanaged, whereas the non-ADHD partner feels lonely, ignored and tired of being the only responsible party in the relationship.

Here’s a framework for creating teamwork: 

  1. Divide tasks and stick to them. The non-ADHD partner may be more suited to handling the bills and doing the errands, while the ADHD partner manages the children and cooking.
  2. Schedule weekly sit-downs. Meet once a week to address issues and assess progress made as a couple.
  3. Evaluate the division of labor. Make a list of chores and responsibilities and rebalance the workload if either one of them is shouldering the bulk of the load.
  4. Split up individual tasks, if necessary. If the partner with ADHD has trouble completing tasks, the non-ADHD partner may need to step in as the “closer.” Account for this in arrangements to avoid resentments.
  5. Laugh together. Lighten up, find humor in the gaffes, mess ups – it’s the greatest tension release ever!

Disorganization

Disorganization is at its worst when someone has no idea where something is and has no clue where to look for it. So getting organized for those with adult ADHD means shrinking their world – keys, cellphones, other personal items can’t just be dropped anywhere; bills, appointments, obligations and documents must be assigned to designated places, accompanied by a system for managing them. Organization though shouldn’t be laborious, because it could become its own distraction. Simple and streamlined processes work just fine.

Organizing for those with adult ADHD:

  1. Because of poor attention, inability to focus, impulsivity, forgetfulness and poor listening skills, a visual plan works best.
  2. Purchase a spiral notebook – it goes everywhere. Note the day and date at the top of the page, then record pickups, appointments, errands for that day only.
  3. Set up a “launching pad” near the front door for backpacks, purses, keys, briefcases, phones. Use cubbies, pegs, containers as needed.
  4. Can you set a 25-minute clock to work in shorter blocks?
  5. Talk with your boss or supervisor about your ADHD.
  6. Take one or two brief mental breaks during the course of a work hour.
  7. Set up a document “hotspot” for important papers, tax returns, payables and receipts.
  8. Enlist an accountability partner for everything mentioned above.

It is incumbent upon those adults living with ADHD to seek out all possible intervention strategies for managing this potentially debilitating disorder. Medication alone is not enough.

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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.